Intrathecal Trastuzumab Administration in Metastatic Breast Cancer Patients Developing Carcinomatous Meningitis

Metastatic Breast Cancer Clinical Trial

— HIT  

Official title:

Phase 1-2 Study of Safety and Efficacy of Intrathecal Trastuzumab Administration in Metastatic HER2 Positive Breast Cancer Patients Developing Carcinomatous Meningitis

Clinical Trial Details — Status: Completed

Administrative data

• NCT number: NCT01373710
• Other study ID #: 09/501/M
• Secondary ID: 2009-017218-63
• Status: Completed
• Phase: Phase 1/Phase 2
• Start date: May 19, 2011
• Est. completion date: April 9, 2018

Study information

• Verified date: July 2019
• Source: Institut Curie
• Contact: n/a
• Is FDA regulated: No
• Study type: Interventional

Clinical Trial Summary

The purpose of this study is:

Phase I: To determine the Trastuzumab maximum tolerated dose (MTD) when weekly administrated by intrathecal or intraventricular route to reach a intra CSF target concentration (30 µg/mL) near the conventional therapeutic concentration and depending on the dose-limiting toxicity (DLT)

Phase II: Determination of antitumor activity trastuzumab when administrated by IT or intra-ventricular in terms of neurological progression-free survival at 2 months

Description:

Phase I: Secondary Outcome Measures:

Recommended dose (RD will be used in Phase II) Toxicity during treatment Clinical response to specific neurologic symptoms Time to neurologic progression Biological response: CSF cellularity and protein concentration Radiological response: cerebrospinal meningitis and neuraxis RMI Impact on quality of life Impact on survival (overall survival, survival without neurological progression, progression-free survival) Pharmacokinetics: dose of trastuzumab in CSF and plasma FCGR3A Genetic status influence on efficacy trastuzumab in metastatic breast cancer

Phase II: Secondary Outcome Measures :

Toxicity during treatment Clinical response to specific neurologic symptoms Time to neurologic progression Biological response: CSF cellularity and protein concentration Radiological response: cerebrospinal meningitis and neuraxis MRI Impact on quality of life Impact on survival (overall survival, survival without neurological progression, progression-free survival) Pharmacokinetics: dose of trastuzumab in CSF and plasma (confirmation of phase I data with 5 patients) FCGR3A Genetic status influence on efficacy trastuzumab in metastatic breast cancer

Recruitment information / eligibility

• Status: Completed
• Enrollment: 34
• Est. completion date: April 9, 2018
• Est. primary completion date: April 2018
• Accepts healthy volunteers: No
• Gender: All
• Age group: 18 Years and older

Eligibility

Inclusion Criteria:

• Metaplastic Infiltrating adenocarcinoma of the breast

• HER2 Overexpression by IHC and / or amplification (FISH and or ICHS)

• Positive diagnosis of neoplastic meningitis: positive CSF cytology (obtained within 28 days before inclusion) AND / OR clinical symptoms of neoplastic meningitis and aspect of tumoral meningitis on MRI

• Brain metastases are allowed without prior treatment, if they are asymptomatics and without engagement. In cases of symptomatic brain metastases, subjects could be included only if surgery and / or radiotherapy (stereotactic or in toto) were performed and if the cerebral metastatic localization allow IT or intra-ventricular treatment. The last radiotherapy session or the surgery must have been done 3 weeks before.

• Aged 18 years old or more

• Male and female

• Life expectancy more than 2 months

• Satisfactory Cardiac function: left ventricular ejection fraction (LVEF) determined by ultrasound scan or myocardial scintigraphy

• Adequate Biological functions 14 days before inclusion, according to the criteria below: Neutrophils > 1.0 x 109/L, Hemoglobin > 9.0 g/dL (+ transfusion if needed,Platelets > 50 x 109/L,Bilirubin < 3 x N, ALT & AST < 10 x N, Creatinine < 2.0 mg/dL, Clearance > 25 mL/min (Cockcroft and Gault formula), Prothrombin time > 70 %, Kaolin cephalin coagulation time < 1.5 x N.

• Women of childbearing potential, must take adequate birth control measure during the study period and must have a negative pregnancy test (BetaHCG serum)

• The subjects must perform all evaluations of pre-inclusion, as provided by the protocol

• Signed written inform consent

Exclusion Criteria:

• CSF circulation disorders suspected on MRI brain (obstructive hydrocephalus) or medullar (obstacle) with, in case of a focal radiotherapy on obstructive lesion, checking the restoration of transit traffic by isotope CSF

• Anti-coagulant effective dose treatment when trastuzumab administration by lumbar puncture

• Patient on Lapatinib (wash out> 2 weeks from the date of first dose intrathecal trastuzumab)

• Known or suspected trastuzumab allergy

• Contraindications of trastuzumab administration, including cardiac diseases: LVEF <laboratory lower limit of normal or any other heart condition which would expose the subject to an unreasonable risk if he were to participate in the study

• Severe toxicity unresolved or unstable related to another previous study restricted drug and / or a cancer treatment

• Ventriculoperitoneal or atrial shunting excepted if the valve could be turn off (on-off switch) and the patient can stand it during 6 h after each injection of trastuzumab

• Dementia, altered mental status or psychiatric condition that would prevent the subject to understand or give informed consent

• Pre-existing severe cerebrovascular disease, such as stroke in a major vessel, vasculitis in the central nervous system or malignant hypertension

• Uncontrolled infection

• Participation in a clinical study with an experimental molecule

• No affiliation to a Social insurance (beneficiary or assignee)

• Pregnant women, breastfeeding or of childbearing age not taking contraceptive

• Subject unable to make follow up schedule

• Persons deprived of liberty or under guardianship (including curators)

Related Conditions & MeSH terms

• Breast Neoplasms
• Carcinomatous Meningitis
• Meningeal Carcinomatosis
• Meningitis
• Metastatic Breast Cancer

Intervention

Drug:
• Trastuzumab
One injection per week during 8 weeks by lumbar puncture or Ommaya Reservoir. 4 levels of doses are expected from 30 mg to 150 mg

Locations

Country	Name	City	State
France	Institut Bergonié	Bordeaux
France	François Baclesse Center	Caen	Calvados
France	CHU Grenoble	Grenoble
France	Oscar Lambret Center	Lille	Nord
France	Léon Bérard Center	Lyon	Rhone
France	Institut du Cancer de Montpellier	Montpellier
France	Institut Curie - Claudius Regaud Hospital	Paris	Ile De France
France	Pitie Salpetriere Hospital	Paris	Ile De France
France	Rene Huguenin Hospital	Saint-Cloud	Haut De Seine
France	Institut Univesitaire du Cancer de Toulouse	Toulouse

Sponsors (10)

Lead Sponsor	Collaborator
Institut Curie	Centre Francois Baclesse, Centre Leon Berard, Centre Oscar Lambret, Groupe Hospitalier Pitie-Salpetriere, Hoffmann-La Roche, Institut Bergonié, Institut du Cancer de Montpellier - Val d'Aurelle, University Hospital, Grenoble, University Hospital, Toulouse

Country where clinical trial is conducted

France, 

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	Phase I : To determine the Trastuzumab maximum tolerated dose (MTD) when weekly administrated by intrathecal or intraventricular route.	Phase I : To determine the Trastuzumab maximimum tolerated dose (MTD) when weekly administrated by intrathecal or intraventricular route to reach a intra CSF target concentration (30 µg/mL) near the conventional therapeutic concentration and depending on the dose-limiting toxicity (DLT).	2 months
Secondary	Phase I : Recommended dose (RD will be used in Phase II)		2 months
Secondary	Phase I&II : Toxicity during treatment	Issued the Common Terminology Criteria for Adverse Events (CTCAE) Version 4.0 National Cancer Institute (NCI)	2 months
Secondary	Time to neurologic progression		2 years
Secondary	Biological response: CSF cellularity and protein concentration		2 years
Secondary	Radiological response: cerebrospinal meningitis and neuraxis MRI		2 years
Secondary	Impact on quality of life		2 years
Secondary	Impact on survival (overall survival, survival without neurological progression, progression-free survival)		2 years
Secondary	Pharmacokinetics: dose of trastuzumab in CSF and plasma		2 months
Secondary	FCGR3A Genetic status influence on efficacy trastuzumab in metastatic breast cancer		2 years
Secondary	Phase II : Determination of antitumor activity trastuzumab when administrated by IT or intra-ventricular in terms of neurological progression free survival at 2 months		2 month